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Key points
- Marginalized communities advocate for their right to self-identify with language that affirms their identity.
- This shift represents a move toward more personalized care that focuses on respect and understanding.
- This shift in language also reflects broader cultural movements around identity and self-determination.
At a training the other day on the topic of homelessness, a participant stood up during the question-and-answer section and shared his perspective for the audience. "I appreciate you trying to be respectful by using person-first language," he began, "but I am homeless. I am not an unhoused person."
I turned my head toward the speaker as murmurs filled the conference hall. "Go on," the speaker urged of this participant. "I have been homeless off and on for the past decade, largely due to my mental health and addiction issues. I appreciate my doctors and my social workers trying to speak about me and my peers in a respectful way, but it always feels distant. Like I can tell they don't understand."
Silence filled the room as we all reflected on this. I saw heads nod in agreement.
"I think we should listen to those who have lived experience, and ask them how they want to self-identify," he continued.
Language Has Power
Language shapes the way we view and interact with the world around us, and in healthcare, the words used to describe those we serve can affect their experience and treatment.1 For decades, "person-first" language has been the standard in healthcare settings—most of us were trained to use this language.1 But, recently, some are questioning whether this approach is still the best, or whether healthcare is moving away from it.
What Is Person-First Language?
Person-first language emerged in the late 20th century as a way to emphasize the humanity of individuals living with medical conditions or disabilities. The idea was simple: By putting the person before their condition, you acknowledge their identity beyond the diagnosis. For example, saying “a person with Down syndrome” was intended to show that Down syndrome was just one part of the person’s life, not their whole identity.
Person-first language gained traction in the disability rights movement, where it was championed by advocates who wanted to shift away from stigmatizing language. It was also seen as a way to reduce the negative stereotypes associated with certain health conditions by focusing on the person rather than the illness or disability.
Criticism of Person-First Language: Does It Actually Increase Stigma?
In recent years, we have been having conversations about how using person-first language may actually increase stigma.2 Some research shows that using person-first language is more common when referring to those who are more stigmatized, such as children with more stigmatized mental health conditions or disabilities, therefore reinforcing their stigma.2,3
Critics of person-first language argue that it can come across as unnatural or even distancing. For example, phrases like "person with diabetes" can feel clinical and overly formal. In some cases, the structure of the language may unintentionally reinforce the idea that the condition is something external or separate from the individual. As a result, some patients may feel that their condition is being minimized or overlooked, as though it's something to be ashamed of rather than something that makes them unique.
Additionally, there are concerns that the widespread use of person-first language may reflect a more paternalistic view of healthcare, where professionals impose their language preferences on patients without considering the patient's own preferences.
The Shift Toward Identity-First Language
Despite its original intentions, person-first language has recently been called into question by those with lived experience, with some arguing that it may not be the most respectful or accurate way to describe people. One alternative gaining popularity is identity-first language, where the condition or identity comes before the person. This shift toward identity-first language is often seen as a reflection of the growing movement to empower individuals to define their own identities, especially in the context of medical care.
An example of this is saying "autistic person" rather than "person with autism." This shift is particularly common in the autism community, where many individuals prefer identity-first language because it embraces their condition as an integral part of their identity rather than something to be separated from who they are.5 "Being autistic is my identity," one client said to me; "why separate it from myself?" As an autistic person, this made sense to me.
Devon Price is a queer autistic who advocates for this perspective, emphasizing that for many autistic people, their neurodivergence is not something that should be detached from their identity, but rather a core aspect of who they are. In their work, Price highlights how embracing identity-first language allows autistic individuals to assert pride in their neurodivergence, challenging societal perceptions that view it as something inherently negative or in need of fixing.5
For some, referring to someone with person-first language implies that it is something to be "fixed" or that it is an undesirable characteristic. Using identity-first language can convey that the individual is not defined solely by their diagnosis, but that it is a significant and inherent part of their identity.
As more marginalized communities advocate for their right to self-identify, many have embraced language that affirms their identity, rather than separating them from their condition.
Instead of assuming that all patients prefer person-first language or any other specific terminology, healthcare providers are increasingly being encouraged to ask patients how they would like to be referred to and to honor those preferences. For example, a social worker might say, “What language feels most comfortable for you when talking about your health?” In some cases, these conversations can also prompt deeper discussions about patient identity and experiences, giving healthcare providers an opportunity to connect with patients in more meaningful ways.
As the healthcare field continues to evolve, it's likely that we’ll see even more changes in how we talk about medical conditions and disabilities. The more we listen to individuals about how they wish to be referred to, the more we create an environment where patients feel seen and understood, not just as cases or conditions, but as whole people.
References
1. Crocker AF, Smith SN. (2019). Person-first language: are we practicing what we preach? J Multidiscip Healthc. 8;12:125–129.
2. Gernsbacher MA. (2017). Editorial Perspective: The use of person-first language in scholarly writing may accentuate stigma. J Child Psychol Psychiatry. 58(7):859–861.
3. Grandits J, Davis A, Rikard B, Vatrano A, Martin H, Taylor MA. (2023). Disability terminology: the use of "disability," "disorder," and "illness" in academic writing. Disabil Rehabil. 46(20):4664–4674.
4. Collier R. (2012). Person-first language: laudable cause, horrible prose. CMAJ. 11;184(18):E939–40.
5. Price, D. (2022). Unmasking Autism: Discovering the New Faces of Neurodiversity. TarcherPerigee
